Saturday Quiz

Designed to enlighten and amaze.


Coding tools in the electronic health record are time-consuming to interpret and not always correct.

Which of the following conditions are risk codes associated with an increase in capitation—and how would you find out?


A. Old MI

B. Shortness of Breath

C. Mild Intermittent Asthma

D. Chronic anemia, not otherwise specified

E. Low Back Pain



The astonishing answer next week.




Last week’s answer


A patient you haven’t seen in over a year underwent a bone density test where an osteoporotic compression fracture was noted. Do you:



A. Submit the code for the pathologic vertebral fracture using an addendum to the test interpretation charge.

B. Invite the patient to come in and discuss.

C. Call the patient to inform her of the diagnosis and submit the code from that call.

D. Do nothing. The code will be submitted by the test interpretation charge and you can discuss the problem at the patient’s next annual wellness visit.



B. Invite the patient to come in and discuss.

You can’t submit risk codes from test interpretation charges and telephone calls are not qualified visits for code submission (yet anyway).

Get her in, address the problem, submit the code then.

That’s the great thing about Medicare Advantage—the system rewards delivering great care.